Body dysmorphic disorder (BDD) is a rare disease. Although described in the last century it was only recently classified in the DSM-IV. BDD is characterized by an excessive concern about an imagined deformity of the body. Establishing the diagnosis of BDD remains to be demanding, yet of utmost importance for the surgeon. Only a timely diagnosis will prevent dissatisfaction of both the patient and the surgeon. In this article, strategies to cope with such patients after diagnosis are described.